甲状腺手术方式和喉返神经显露与神经损伤的关系  

Relation of recurrent laryngeal nerve injury with surgical approach and exposure of the nerve in thyroidectomy

作　　者：程若川[1] 苏艳军[1] 张建明[1] 罗华友[1] 魏晓刚[1] 刁畅[1] 

机构地区：[1]昆明医学院第一附属医院胃肠与甲状腺外科,云南昆明650032

出　　处：《中国普通外科杂志》2007年第1期15-17,共3页China Journal of General Surgery

摘　　要：目的探讨甲状腺手术切除范围和喉返神经显露与喉返神经损伤的关系。方法回顾2142例甲状腺手术患者的临床资料,共行3744侧手术,1986侧手术显露喉返神经,1758侧未显露。结果返神经损伤20例(侧),损伤率为0.93%(20/2142),永久性损伤率为0.37%(8/2142);喉返神经显露组损伤率0.30%(6/1986)显著低于非显露组0.80%(14/1758)(P<0.05)。行甲状腺部分切除、侧叶次全切除、侧叶切除及颈淋巴结清扫者喉返神经损伤率依次增高,且非显露组高于显露组,但无统计学意义(P>0.05)。结论术中仔细地显露和辨认喉返神经在一定程度上可以减少或避免神经的损伤。Objective To explore the relation of recurrent laryngeal nerve damage with the mode of surgery and exposure of the nerve in thyroideetomies. Methods We retrospectively reviewed the clinical data of 2142 thyroideetomy patients. There were 540 unilateral and 1602 bilateral procedures with 3744 nerves at risk of injury. Among them, 1986 nerves were explored and indentified, and 1758 nerves were not exposed. Results The overall incidence of recurrent laryngeal nerve injury was 0.93 % （20/2142 ） , and with an incidence of 0.37% （8/2142）for permanent damage. The injury incidence in the nerves exposure and nonexposure groups was 0. 30% and 0. 80% , respectively, the difference was significant between the two groups （ P 〈 0.05 ）. The injury rate of nerves at risk for partial lobeetomy, subtotal lobeetomy, lobeetomy and lobectomy plus ipsolateral neck dissection was increased in that order, and the incidence was higher in non-exposure group than in exposure group, but with no statistical significance（ P 〉0.05 ）. Conclusions The occurrence of recurrent laryngel nerve injury can be reduced or avoided by its careful exposure and identif ication during thyroid operation.

关 键 词：甲状腺切除术/副作用 喉返神经/损伤 手术后并发症/预防与控制 

分 类 号：R653.2[医药卫生—外科学] R736.1[医药卫生—临床医学]